In the related art, surgery, such as neurosurgery, for example, brain tumors are typically excised through an open craniotomy approach guided by imaging. The data collected in these solutions typically consists of CT scans with an associated contrast agent, such as iodinated contrast agent, as well as MRI scans with an associated contrast agent, such as gadolinium contrast agent. Also, optical imaging is often used in the form of a microscope to differentiate the boundaries of the tumor from healthy tissue, known as the peripheral zone. Tracking of instruments relative to the patient and the associated imaging data is also often achieved by way of external hardware systems such as mechanical arms, radiofrequency, or optical tracking devices. As a set, these devices are commonly referred to as surgical navigation systems and are often cumbersome and provide inaccurate tracking.
Port-based surgery is a minimally invasive surgical technique where a port is introduced to access a surgical region of interest using surgical tools. Unlike other minimally invasive techniques, such as laparoscopic techniques, a port diameter is larger than a tool diameter. Hence, the tissue region of interest is visible through the port, wherein exposed tissue in a region of interest, at a depth few centimeters below the skin surface, is accessible through a narrow corridor in the port.
Several related art problems generally preclude or impair the ability to perform port-based navigation in an intra-operative setting. For example, the position of the port axis relative to a typical tracking device (TD) is a free and uncontrolled parameter that prohibits the determination of access port orientation. Further, the limited access which is available, due to the required equipment for the procedure, causes indirect access port tracking to be impractical and unfeasible. Also, the requirement for angulation of the access port to access many areas within the brain during a procedure makes navigation of the access port a difficult and challenging problem that has not yet been addressed.
Further, a recent paper by Stieglitz et al., “The Silent Loss of Neuronavigation Accuracy: A Systematic Retrospective Analysis of Factors Influencing the Mismatch of Frameless Stereotactic Systems in Cranial Neurosurgery,” highlights the need for accurate navigation, wherein after patient registration, an ongoing loss of neuronavigation accuracy remains due to other mitigating factors related to the surgical procedure, i.e., draping, attachment of skin retractors, and duration of surgery. Surgeons should be aware of this “silent” loss of accuracy when using related art navigation systems.
In some related art systems, surgeon positioning is merely defined by a small set of pre-defined positions. In other related art systems, the images are displayed in a manner that is counter-intuitive, e.g., upside-down, incorrect angular orientation, left-right confusion, and the like, necessitating mental correction by the user, whereby surgical errors and medical malpractice may loom.
Accordingly, challenges experienced in the related art include an inability to present an accurate navigation view to a user, such as surgeon, that is aligned or oriented with a surgical view. Therefore, a need exists for systems and methods that, not only integrates and updates pre-operative and intra-operative plans into navigation systems for minimally invasive surgical procedures, such as an improved system and method for mapping navigation space to patient space in a medical procedure, but also for systems and methods that provide a navigation view to a user that is aligned or oriented with the surgical view.